足三里穴和天枢穴穴位注射新斯的明改善重症急性胰腺炎患者胃肠动力的临床观察

Clinical observation on injection of Neostigmine at acupoints of Zusanli and Tianshu to improve gastrointestinal motility disorder in patients with severe acute pancreatitis

目的 观察新斯的明穴位注射足三里穴、天枢穴改善重症急性胰腺炎(SAP)患者胃肠道动力的临床疗效.方法 采用前瞻性研究方法.选择2008年1月至2021年5月遵义医科大学附属医院收治的90例SAP患者作为研究对象,按随机数字表法将患者分为对照组、足三里穴组、足三里穴+天枢穴组,每组30例.对照组以新斯的明1 mg臀部肌肉注射,q12 h;足三里穴组双侧足三里穴位注射新斯的明,每穴位0.5 mg,q12 h;足三里穴+天枢穴组双侧足三里穴和天枢穴行穴位注射新斯的明,每穴位0.25 mg,q12 h,均治疗4 d.治疗后1、3、5 d观察各组腹内压、肠鸣音、空腹胃窦收缩频率、胃残余量、给药后第1次排便时间、24 h大便量,以及心率(HR)、呼吸频率(RR)、氧合指数(PaO_(2)/FiO_(2))、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、前白蛋白、C-反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-6(IL-6)水平的变化.结果 ① 在患者腹腔状态指标改善方面,与对照组比较,治疗后5 d足三里穴组腹内压明显降低〔cmH_(2)O(1cmH_(2)O≈0.098 kPa):13±4比17±3〕;与足三里穴组比较,治疗后3 d足三里穴+天枢穴组腹内压明显降低(cmH_(2)O:15±4比21±5),肠鸣音、空腹胃窦收缩频率增加〔肠鸣音(次/min):3±1比2±1,空腹胃窦收缩频率(次/min):1.5±0.3比1.0±0.3〕,胃残余量减少(mL:84.1±1.5比135.1±11.7),给药后第1次排便时间明显缩短(min:13±5比15±5),24 h大便量明显明显增多(g:880±125比680±126),差异均有统计学意义(均P<0.05).② 在常规监测及生化指标的变化方面,与对照组比较,治疗后5 d足三里穴组HR、CRP水平均明显降低〔HR(次/min):119±12比130±12,CRP(mg/L):130.2±22.4比170.2±19.4,均P<0.05〕,前白蛋白明显升高(mg/L:128.0±20.6比105.0±20.5,P<0.05);与足三里穴组比较,治疗后5 d足三里穴+天枢穴组HR、CRP、IL-6均明显降低〔HR(次/min):103±14比119±12,CRP(mg/L):103.7±17.5比130.2±22.4,IL-6(ng/L):33.3±11.2比45.3±10.9,均P<0.05〕,PaO_(2)/FiO_(2)、前白蛋白均升高〔PaO_(2)/FiO_(2)(mmHg,1 mmHg≈0.133 kPa):265±11比259±12,前白蛋白(mg/L):137.5±11.1比128.0±20.6〕,但差异无统计学意义(均P<0.05).结论 足三里穴+天枢穴新斯的明穴位注射能明显改善SAP患者的胃肠道动力,并减轻全身炎症反应.

Objective To investigate the clinical effect of Neostigmine injection at acupoints of Zusanli and Tianshu in patients with severe acute pancreatitis(SAP)and gastrointestinal motility disorder.Methods A prospective research method was conducted,90 SAP patients with SAP admitted to the Affiliated Hospital of Zunyi Medical University from January 2008 to May 2021 were selected as the research objects.According to the random number table method,the patients were divided into 3 groups:control,Zusanli point and Zusanli point+Tianshu point groups,with 30 cases in each group.he patient in control group was injected intramuscularly with neostigmine I mg,q12 hours in the Zusanli group,the patient was injected with neostigmine at bilateral Zusanli points,0.5 mg,ql2 hours per one acupoint;in the Zusanli point+Tianshu point group,the bilateral acupoints of both sites were injected with 0.25 mg per one acupoint,q12 hours,and all the patients were treated for 4 days,The levels of heart rate(HR),respiratory rate(RR),oxygenation index(PaO_(2)/FiO_(2)),alanine aminotransferase(ALT),aspartate aminotransferase(AST),prealbumin,C-reactive protein(CRP),leukocyte count(WBC)and interleukin-6(IL-6)were detected,and the changes of intraabdominal pressure,intestinal sound,fasting gastric antrum contraction frequency,gastric residual volume,the first defecation time and 24-hour defecation volume after treatment were observed on the I,3 and 5 days after treatment in the three groups.Results In terms of patients in improvement of abdominal state indexes,compared with the control group,the intra-abdominal pressure in Zusanli point group was decreased significantly 5 days afer treatment[cmH,0(1 cmH,0=0.098 kPa):13±4 vs.17±3]:compared with the Zusanli point group,on the 3rd day afer treatment,the intra-abdominal pressure in the Zusanli point+Tianshu point group was decreased significantly(cmH,O:15±4 vs.21±5),the bowel sounds and fasting antrum contraction frequency were increased[bowel sounds(times/min):3±1 vs.2±1,the fasting gastric antrum contraction frequency(times/min)1.5±0.3 vs.1.0±0.3],gastric residual volume decreased(mL:84.1±1.5 vs.135.1±11.7),the first defecation time was significantly shortened after administration of drug(minutes:13±5 vs.15±5),the amount of stool in 24 hours was significantly increased(g:80±125 vs.680±126),the dfferences being statistially significant all P<0.05).@In terms of routine monitoring and the changes of biochemical indexes,the levels of HR and CRP were significantly lower[HR(times/min):119±12 vs.130±12,CRP(mg/L):130.2±22.4 vs.170.2±19.4,all P<0.05],and prealbumin was higher significantly(mg/L:128.0±20.6 vs.105.0±20.5,P<0.05)in Zusanli point group than those in the control group on the 5th day afer treatment.Compared with Zusanli point group,the levels of HR,CRP and IL-6 were lower significantly[HR(times/min):103±14 vs.119±12,CRP(mg/L):103.7±17.5 vs.130.2±22.4,IL-6(ng/L):33.3±11.2 vs.45.3±10.9,all P<0.05],while the levels of PaO_(2)/FiO_(2)and prealbumin were higher significantly[PaO,/Fi0,(mmHg,1 mmHg=0.133 kPa):265±11 vs.259±12,prealbumin(mg/L):137.5±11.1 vs.128.0±20.6,all P<0.05)on the 5th day afer treatment in the Zusanli point+Tianshu point group.Conclusion Zusanli point+Tianshu point neostigmine acupoint injection can significantly improve gastrointestinal motility and reduce systemic inflammation in patients with SAP.